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Sommers J.1, Wieferink D.1, Nollet F.1, Dongelmans D.2, Engelbert R.H.H.1,3, van der Schaaf M.1,3
1Academic Medical Center, University of Amsterdam, Rehabilitation, Amsterdam, Netherlands, 2Academic Medical Center, University of Amsterdam, Intensive Care Medicine, Amsterdam, Netherlands, 3ACHIEVE - Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, Netherlands
Background: Up to 65% of the Intensive Care Unit (ICU) patients develop ICU acquired muscle weakness (ICU-AW) due to inactivity and critical illness.1 ICU- AW is strongly associated with short- and long- term physical impairments and impaired functional status.2 It has been shown that early mobilization and ambulation of patients admitted to the ICU improve functional recovery. 3-9 From the rehabilitation perspective, one wants to start with ambulation with critically ill patients as early as possible as this is considered as an essential skill for independent functioning and it improves overall muscle strength and endurance.However, the implementation of these interventions remains difficult within physiotherapy practice due to safety and practical issues. To illustrate, ambulation with ICU patients is difficult, because of the reduced muscle strength, as well as the limited length of infusion lines, drains and mechanical ventilation tubes. To be able to start earlier with ambulation with critically ill patients we developed a transportable body weight-supported treadmill (BWST) for the use in the ICU.
Purpose: This study aimed to explore the feasibility of Body Weight-Supported Treadmill Training (BWSTT) in ICU patients.
Methods: Twenty patients of the ICU of the Academic Medical Center with m. quadriceps muscle strength MRC ≥ 2, sitting mobility, who had been on mechanical ventilation for more than 48 hours and who fulfilled the safety criteria for exercise according to the Evidence Statement for ICU Physiotherapy were enrolled in the study.10
The BWSTT consisted of walking on a treadmill positioned at the bedside of the patient. A safety harness with a weight bearing utility supported the patients. The BWSST was stopped if the patient was fatigued or safety criteria were violated. The feasibility of the BWSTT was evaluated according to:
· Number of, and reasons that sessions could not be completed;
· (Serious) Adverse Events ((S) AEs);
· Number of staff needed and treatment duration;
· Patient satisfaction;
· Acceleration of the first time to ambulation
Results: BWSTT was performed in twenty patients and 54 sessions. This study showed that BWSTT is feasible with patients in the ICU. There were no (S)AEs, the patients were very satisfied with the BWST, were not anxious (median/ (IQR ) of NRS 0-10: 0 (0-5)) and the needed number of staff was 2 persons with a median duration of 25 minutes treatment time.
All participants should not have been able to walk or should have walked shorter distance without the BWST.
Conclusion(s): BWSTT is feasible and safe and facilitates early ambulation with critically ill patients in the ICU. Moreover, in order to perform BWSTT less staff is necessary compared to ambulation without BWSTT.
Implications: This study shows that novel technology of a BWST enhances rehabilitation and ambulation training in critically ill patients with severe muscle weakness.
Funding acknowledgements: Inapplicable.
Topic: Critical care
Ethics approval: The AMC local Ethics Committee (Amsterdam, the Netherlands, NL56342.018.16). Written informed consent was obtained from all participants
All authors, affiliations and abstracts have been published as submitted.
